Journal Article > Commentary

Insufficient teamwork can exacerbate communication errors and misunderstandings. This commentary explains how sensemaking can enhance communication among team members and describes strategies to promote team sensemaking.

As implementation of comprehensive health information technology (IT) systems becomes more widespread, concern regarding the unintended consequences of such technologies has increased as well. Usability testing is helpful for optimizing implementation of health IT. Researchers analyzed the impact of health IT use on relationships among clinicians over a year-long period across three academic intensive care units. In the two units with higher health IT use, clinicians were more likely to work in an isolated manner, which was associated with an adverse effect on situational awareness, communication, and patient satisfaction. A previous PSNet perspective discussed some of the pitfalls in the development, implementation, and regulation of health IT and what can be learned to improve patient safety going forward.

Journal Article > Commentary

Team support and respect are key elements of a culture of safety. This commentary highlights how clinicians can experience disrespectful encounters with patients and explains why insufficient awareness and reporting by team members of such incidents can normalize the behavior to diminish the safety of the practice environment.

Journal Article > Study

Frontline providers possess unique insights for improving patient safety and their perceptions may be different from those of managers and clinical leaders. In this qualitative study, researchers sought to harness this expertise and perspective through a multifaceted intervention that involved structured multidisciplinary briefings, increased organizational awareness of challenges identified by frontline providers, and feedback—referred to as prospective clinical team surveillance. They found that the prospective safety intervention created a sense of psychological safety in which team members were more likely to raise concerns without fear of punishment and increased frontline provider engagement in improvement opportunities. The authors emphasize that such an approach provides managers with better insights into issues affecting care delivery. A past PSNet perspective discussed workarounds and resiliency on the front lines of health care.

Hospitals rely on incident reporting systems to detect safety issues, but these systems are voluntary and do not capture all adverse events or near misses. Researchers developed and tested a prospective surveillance tool to identify teamwork errors in the pediatric intensive care unit. They found that this tool helped uncover safety issues not captured by the hospital's patient safety reporting system.

Psychological safety can empower staff to communicate concerns and offer suggestions in a collaborative way that contributes to effective care. This review spotlights the importance of high-quality communication to help teams manage the complexity of oncology care regimens, geographically dispersed team members, and hierarchy. The authors advocate for further evidence to understand how to improve psychological safety for care team members and patients.

Special or Theme Issue

Team-based care has been adopted in various specialties as a strategy to reduce handoff errors and omissions. Highlighting the work of a collaborative project to apply team science to oncology, articles in this special issue explore topics such as engaging patients as team members, the role of psychological safety, and use of shared mental models to augment cancer care.

Journal Article > Study

Diagnostic error represents a significant source of patient harm. In this study, researchers surveyed physicians to understand how to improve the involvement of laboratory professionals in assisting with diagnostic challenges. They conclude that there may be a greater role for laboratory professionals in the diagnostic process beyond providing test results.

Journal Article > Study

Teamwork training can improve communication and prevention of adverse events in the operating room. In this study, focus groups with clinicians and operating room staff found that team members perceived the concept of the "team" and their roles in ensuring optimal handoff communication differently. This exploratory work has implications for the design of effective teamwork training programs.

Newspaper/Magazine Article

Bullying and disruptive conduct hinder teamwork and diminish the safety of care delivery. This article discusses how policies, organizational guidelines, and educational strategies can help nurse leaders develop the skills to address unprofessional behaviors in the workplace.

Journal Article > Study

Although checklists have been shown to improve safety and surgical mortality, they can be difficult to implement, which limits their effectiveness in clinical practice. This study examined whether perceptions of teamwork predicted checklist performance. Trained observers used standardized tools to rate the extent of checklist completion and quality of teamwork. They found that checklists were implemented as intended in only 3% of cases. Surgical teams with better surgeon buy-in to checklists, clinical leadership, communication, and overall teamwork completed more checklist components. Clinical factors, including older patient age and longer duration of surgery, were also associated with performing more of the checklist. The authors suggest that teamwork is critical to checklist implementation. A PSNet interview discussed the challenges of implementing checklists in health care.

Teamwork and clinician well-being have important implications for patient safety. Researchers conducted a systematic review of the literature and found evidence supporting independent relationships between teamwork, clinician well-being, and patient safety. The authors propose a framework that addresses current limitations and suggest that further research is needed to better understand the causal relationships between the three concepts.

Although leadership at the team and organizational level is considered crucial for safety, training to support this role is needed. Discussing how to improve leadership skills in maxillofacial surgery, this review describes key attributes that surgeons in leadership roles should develop—including professionalism, motivation, and innovation—to enhance quality of care.

Journal Article > Review

In teamwork training, multidisciplinary health care teams learn to respond effectively to acute situations. Prior studies of team training show improvements in safety culture, but its effect on patient outcomes has been mixed. This meta-analysis of 129 studies found that team training consistently led to enhanced participant satisfaction and skills. These improvements were present across different health care settings and team composition. Investigators also determined that team training positively affects length of stay and mortality, although they caution that few of the primary studies analyzed included these patient outcomes. The authors suggest that team training should be widely implemented and that further studies should evaluate its effect on length of stay, patient satisfaction, and mortality. A PSNet interview discussed how team training from other industries can be applied to health care.

Journal Article > Study

Emotional exhaustion is a component of burnout—a critical patient safety issue. Teamwork promotes resilience and thus may protect against burnout and promote patient safety. However, it is unclear how teamwork, burnout, and patient safety interact in a safety culture. This prospective study of critical care interprofessional teams found that clinicians' emotional exhaustion affects teamwork, which leads to worsening clinician reports of patient safety. The authors suggest addressing clinicians' emotional exhaustion prior to team training in order to best augment patient safety in the intensive care unit. A PSNet interview discusses strategies to enhance clinicians' emotional resilience.

SBAR has been widely implemented to improve communication in health care settings. This simulation study compared the use of SBAR with a newly developed Traffic Lights tool to assess the communication between anesthesia teams in different operating rooms in 12 validated clinical scenarios. The authors found that the new tool yielded more accurate information transfer, took less time to use, and was preferred by the majority of study participants.

Journal Article > Study

The Team Checkup Tool stemmed from work done as part of the Keystone ICU project and is designed to identify barriers to the progress of quality improvement initiatives. In this study, investigators used focus groups and feedback sessions to assess the content of the tool. They conclude that the Team Checkup Tool measures meaningful aspects of team-based quality improvement work.

Journal Article > Study

The I-PASS signout tool has become a widely used method of patient handoffs when transferring care from the primary clinician to a covering clinician. This study used the I-PASS framework to develop and implement a standardized signout process for transferring patients from the pediatric cardiac intensive care unit to the general ward. The new process significantly improved clinician workflow and perceived safety culture relating to handoffs.